Effects of Argatroban and Streptokinase During Extracorporeal Membrane Oxygenation Assisted Cardiopulmonary Resuscitation on Fibrin Deposition in the Porcine Frontal Lobe
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The leading cause of death in the United States is heart disease, with sudden cardiac arrest accounting for approximately 45% of these deaths (Mozaffarin et al., 2015). Though cardiopulmonary resuscitation (CPR) intervention promotes reperfusion of the blood, when administered optimally, it only delivers 30% of normal blood flow to the brain (Meaney et al., 2013). Through employing the extracorporeal membrane oxygenation (ECMO) circuit as an adjunct to CPR, more effective oxygenation to peripheral tissues can occur for cardiac arrest cases. A theorized mechanism of no-reflow is coagulation of microvasculature, ultimately resulting in an extended ischemic insult to the parenchyma of peripheral tissues, particularly the brain. To examine the hypercoagulopathy of the brain post no-reflow, fibrin deposition was measured using immunolabeling techniques in the frontal lobe of the porcine brain. This experiment found a significant difference in percent area of fibrin deposition within the frontal lobe of the porcine brain across all groups (F=103.64, p=2.2e-16). A Tukey HSD post-hoc analysis showed the control-streptokinase group having the highest percent fibrin positive staining and the control-argatroban group having the lowest percent fibrin positive staining. For a more extensive and accurate analysis of fibrin deposition within the brains of these porcine models, a double immunolabeling technique staining for both vasculature and fibrin deposition was developed and optimized.